MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name: Esomeprazole

Trade Name: Nexium

Designated Clinical Areas:

Adult (All, Critical care, General Care, Other)

Action :

Esomeprazole suppresses gastric acid secretion by binding to and inhibiting the hydrogen-potassium-ATP-ase enzymes of gastric parietal cells. Inhibition of hydrogen-potassium-ATP-ase blocks the final step of gastric acid production, leading to inhibition of both basal and stimulated acid secretion.

Indication :

- Massive nonvariceal UGIB

- High risk ulcers (i.e. visible vessel) in post-endoscopy setting

* H2-blockers are recommended for routine prophylaxis of stress ulcers in the ICU

Applicable Policy Statement :

•  Intravenous use requires gastroenterology service approval

•  If patient does not present with UGIB, high risk ulcers in the post endoscopy setting or is not NPO, oral PPI, NG tube

PPI, or IV/PO H2 blockers should be utilized.

Administrative Guidelines :

Usual dose and route :

•  Use for massive non variceal UGIB, High risk ulcers (post-endoscopy)

•  80 mg IV bolus over 30 min followed by an IV infusion at 8 mg/hr for up to 72 hrs duration

•  40 mg IV bolus over 15-30 minutes BID

Standard Concentration

•  80mg/100mL NS

•  40mg/50mL NS

Critical Elements/Special Considerations :

•  IV Nexium should not be administered concomitantly with any other medications through the same intravenous site and or tubing. The intravenous line should always be flushed with either 0.9% Sodium Chloride Injection, Lactated Ringer's Injection, or 5% Dextrose Injection, both prior to and after administration.

Precaution and Side Effects

•  Common: Injection site reaction, abdominal pain, constipation, diarrhea, flatulence, indigestion, nausea, xerostomia, dizziness, headache

•  Serious: erythema multiforme (rare), stevens-Johnson syndrome (rare), toxic epidermal necrolysis (rare) , bone fracture, osteoporosis-related hip fracture, rhabdomyolysis

Approved by : MESAC 4/10